We Make Insurance Easy

HOME
ABOUT
SERVICES
APPOINTMENT
MAKE A CLAIM
LEARN
CONTACT
More

Use tab to navigate through the menu items.

Car Insurance Request Form

Important: Fee For Service

Due to changes introduced by the Financial Sector Reform (Hayne Royal Commission Response) we are now providing assistance with Private and Commercial Motor Vehicle Insurance on a Fee for Service basis with 0% commission at a fixed cost of $250+GST per vehicle per annum plus $50+GST per additional vehicle.

This is similar to the combined commission and fee income that we have received in the past, but it means less paperwork for you and greater transparency.

There is still no upfront fee for the quoting process, fees are only payable should you wish to proceed with our recommendation and arrange cover. There are also no fees payable for us to support you in the event of a claim or if you have any questions during the policy term.

You can read more about these changes here.

Select an option *

New Client

Existing Client

Completed By

Contact Name

Main Driver

Date of Birth

Gender

Phone

Garaging Address

Garaging Method

Vehicle usage *

Private Use

Business Use

Executive Use

Description of business use

Secondary Driver

Date of Birth

Gender

Vehicle 1

Insured Name

Cover Required

Optional Coverage

Hire Car Following Accident

Nil Excess Windscreen

Roadside Assistance (not available with all insurers)

Does the vehicle have any accessories?

Is the car under finance?

Vehicle 2

Add Vehicle

Insured Name

Cover Required

Optional Coverage

Hire Car Following Accident

Nil Excess Windscreen

Roadside Assistance (available with Blue Zebra only)

Does the vehicle have any accessories?

Is the car under finance?

Insurance Status

Cover Required * required

Any claims in the past 3 years? *

Yes

Add claim details

Any loss of licence, driving convictions etc? *

Yes

Add details

Additional notes

PO Box 349, KYNETON VIC 3444

20 High Street, KYNETON VIC 3444

hello@macedonrangesinsurance.com.au

03 4411 2704

Important Information

Insurance Brokers Code of Practice

Our Financial Services Guide

Internal Use

Complaints

Macedon Ranges Insurance Pty Ltd | ABN 65 672 507 191 | AR No. 1283072 Authorised Representative of PSC Connect Ltd ABN 23 141 574 914 AFS License No 344648.

We are a PSC Network Insurance Partner and part of the PSC Insurance Group, a publicly listed multi-national Insurance Broking company with global reach. We have the size and scale to help you protect your operations and assets by providing appropriate advice and the ability to leverage our scale with leading insurers, underwriting agencies, and access to the London insurance market. We benefit from knowledge across a broad range of industries so we can focus our efforts on understanding every customer, every policy and every risk, ensuring our clients have access to a wide range of insurance companies, a broad range of products, and highly-competitive industry pricing.

Disclaimer: The information provided on this website is for general information purposes only, and it is not a substitute for professional advice. You should always consider the PDS/Policy wording before making a decision. Coverage may differ based on specific clauses in individual policies. Refer to the FSG on our website or by requesting a copy for our services and remuneration details.

Macedon Ranges Insurance is a member of NIBA and endorse the Insurance Brokers Code of Conduct which can be found here.

Website by Techno Bird